Hypoglycemia In Pregnancy: Types, Causes, Signs & Treatment

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Low blood sugar (hypoglycemia) in pregnancy is when a mother’s blood glucose levels are too low than recommended. Skipping meals and excessive exercising are possible reasons why a mother can develop low blood sugar levels.

Generally, an occasional dip in blood sugar level during pregnancy is benign. However, regular drops in blood sugar levels can lead to hypoglycemia, which could adversely affect the mother and her unborn baby’s health. Therefore, mothers should closely monitor their blood sugar levels. It’s particularly pertinent if a pregnant woman has risk factors, such as type-1 diabetes.

Keep reading as we tell you about the signs and symptoms, causes, diagnosis, treatment, and prevention of low blood sugar in pregnancy.

Types Of Hypoglycemia In Pregnancy

When a pregnant woman has diabetes, she may have low blood sugar levels due to a mismatch of medicine, food, or exercise. However, when a non-diabetic mother develops low sugar levels, it’s called non-diabetic hypoglycemia (1).

Non-diabetic hypoglycemia is a rare condition that has two types.

  • Reactive hypoglycemia: It usually happens within a few hours of eating a meal and can occur in pregnant women with and without diabetes.
  • Fasting hypoglycemia: This hypoglycemia occurs when blood sugar levels are too low between two meals. It can happen in mothers who have some medical condition affecting the liver, heart, or kidneys.

Symptoms Of Hypoglycemia

A mother with low blood sugar may experience the following symptoms (3).

  • Blurred vision
  • Unexplained fatigue
  • Feeling shaky and light-headed
  • Sweating and chills
  • Mild headache
  • Tingling sensation around lips and tongue
  • Rapid heartbeat
  • Confusion and disorientation

If a mother develops severe hypoglycemia, she may experience adverse symptoms, such as seizures and blackout.

Causes Of Hypoglycemia

Chronic hypoglycemia in non-diabetic pregnant women is rare. A mother could be at risk of developing low blood sugar levels due to the following factors (2).

1. Gestational diabetes

Pregnancy causes several hormonal changes, which, coupled with weight gain, may cause insulin resistance. As a result, the body produces extra insulin to fight insulin resistance (4). However, when raised insulin levels aren’t enough to lower blood sugar levels, gestational diabetes occurs.

A mother with gestational diabetes on diabetes medications, such as insulin, can develop hypoglycemia. It’s highly likely to happen if a mother’s medication or insulin dosages aren’t well-adjusted to her blood glucose levels.

2. Diabetes

A woman with type-1 or type-2 diabetes who takes diabetes medication, such as insulin, is at an increased risk of developing hypoglycemia (5). It can happen if the mother skips her meals or her medications aren’t adjusted as per her sugar levels. Generally, women with type-1 diabetes are at a higher risk of developing hypoglycemia.

3. Morning sickness

Pregnant women need to eat well to nourish themselves and their babies. However, for those with morning sickness, skipping meals and eating less than recommended is common. These factors could increase the risk of developing low blood sugar levels.

4. Medications

Pregnant women should share the details of all the medicines and supplements they take with their healthcare provider. It’s essential because certain drugs, such as anti-diabetic medicines, can interact with other medications and cause blood sugar levels to drop. For instance, salicylates or pain relievers, antibiotics (sulfa drugs), pentamidine, and quinine are some of the drugs that can cause blood sugar to fall (6).

5. Lifestyle factors

A healthy lifestyle helps in the smooth progression of pregnancy. A mother’s chances of developing low blood sugar levels rise if she:

  • Delays or skips meals
  • Consumes too little food than recommended
  • Does excessive exercise
  • Has an eating disorder that makes her overeat or undereat

6. Certain medical conditions

If a mother has certain medical conditions, her chances of developing low blood glucose levels are higher. Some of the conditions that may increase the risk are:

  • Pancreatic tumors
  • Organ failure
  • Hormone imbalances (particularly in cortisol and glucagon)
  • Rare enzyme deficiencies
  • Stomach surgery, causing the food to pass through the small intestine rapidly

Diagnosis Of Hypoglycemia

All pregnant women are tested for gestational diabetes between the 24th and 28th week of pregnancy during a routine antenatal checkup (3). However, if a mother has known risk factors for hypoglycemia, the doctor may order a glucose screening test earlier than usual.

If a woman doesn’t have diabetes, the healthcare professional may order additional tests to determine the cause for low blood sugar levels. Along with blood tests, the doctor will note her symptoms, medical history, and overall health.

Treatment For Hypoglycemia

Treatment for hypoglycemia aims at stabilizing blood sugar levels. In most cases, a mother can achieve this by modifying dietary and lifestyle habits. In certain cases, adjusting the insulin dosage and other hypoglycemia drugs can help.

Regular blood glucose monitoring can help you know whether you are on the right track. Alternatively, if a woman doesn’t have diabetes and some medical condition is causing her sugar levels to drop, treating that condition can be beneficial.

If you feel any of the symptoms of hypoglycemia, check your blood glucose levels and consider the following immediate interventions (7).

  • 10 to 15g of fast-acting carbohydrates, such as three to five dextrose tablets, jellies, or toffees.
  • If none of the above items are available, you can also drink four ounces of a sugary drink, such as pure fruit juice.
  • After the initial intake, eat a slower-acting carbohydrate, such as a bread slice or piece of fruit, to keep your sugar levels in control until the next meal.

Don’t eat fatty foods during a hypoglycemia episode. The fat content of such foods could cause the slow release of sugar.

In rare cases, the doctor may prescribe a glucagon kit. It consists of a synthetic glucagon hormone and a sterile syringe. The individual has to inject glucagon to stimulate the release of stored glycogen from the liver in an episode of severe hypoglycemia.

Prevention Of Hypoglycemia

There’s no precise way to prevent hypoglycemia. However, you can reduce the risk of complications by following some simple measures.

  1. Always carry a fast-acting carbohydrate with you at all times. Sugar candies, jellies, toffees, glucose tablets, and fruit juice are some of the items you can keep. To avoid causing hyperglycemia, ensure you pick foods that contain about 15 grams of fast-acting carbohydrates.
  1. Learn the signs and symptoms of hypoglycemia so that you may stay prepared for it. You can stick a symptoms checklist in your home and at the office desk as well (if needed).
  1. Eat frequent, interval-based, small meals containing complex carbs, fiber, and protein to stabilize your blood sugar levels.
  1. Keep a healthy snack on your bedside table to fight night cravings and hunger pangs without causing major fluctuations in your blood sugar levels.
  1. Exercise regularly unless your doctor has advised you otherwise. Consult your doctor to know the exercises that will suit you well and their duration. Remember, physical activity is essential to utilize glucose, an important mechanism to control your blood sugar levels.
  1. Self-monitor blood sugar levels if you have gestational diabetes or already have type-1 or type-2 diabetes. According to American Diabetes Association (ADA), women with such conditions should self-monitor their fasting and post-prandial (after eating food) sugar levels (8).

Possible Complications Of Hypoglycemia

Occasional hypoglycemia during pregnancy will most likely not do any harm. However, if it gets frequent or turns severe, it may cause life-threatening complications, such as seizures, fits, or coma. A baby born to a hypoglycemic mother may also develop complications, such as (9):

  • Fetal hypoglycemia
  • Fetal hypoinsulinemia

Low blood glucose in pregnancy is uncommon, especially if you don’t have diabetes. Generally, an occasional drop in your blood glucose is benign. But, in cases of frequent lows, you and your baby’s health can be at risk. It’s advisable to keep your sugar levels in control. Remember, preventing hypoglycemia isn’t always possible, but eating at regular intervals, exercising regularly, and monitoring your blood sugar levels can help reduce adversities.

Key Pointers

  • Unexplained fatigue, headache, and rapid heartbeat are signs of hypoglycemia.
  • Diabetes, medications, or lifestyle factors may cause hypoglycemia symptoms in pregnant women.
  • Carrying fast-acting carbohydrates, eating after small intervals, and other preventative measures are discussed below.

References:

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Dr. Annal Vaidya

(MS)
Dr. Annal Vaidya is a former assistant professor of Obstetrics and Gynecology at the prestigious Seth GS Medical College and KEM Hospital, Mumbai. He currently works as a consultant in various hospitals in the city. Dr. Vaidya specializes in managing high-risk pregnancies, infertility, and complicated pregnancies. He has a special interest in Cosmetic Gynecology and Endoscopy.

Swati Patwal

Swati Patwal is a clinical nutritionist and toddler mom with over eight years of experience in diverse fields of nutrition. She started her career as a CSR project coordinator for a healthy eating and active lifestyle project catering to school children. Then she worked as a nutrition faculty and clinical nutrition coach in different organizations. Her interest in scientific writing... more